A Quality Improvement Approach to Reducing Surgical Cancelations Using a Digital Checklist in a Third-Level Hospital

Operating room cancelations have significant implications for hospital resources and patient quality of care. These cancelations lead to inefficient utilization of operating rooms, staff, and equipment, resulting in increased costs and reduced productivity for healthcare facilities. This study evaluated the impact of implementing a mandatory digital preoperative checklist on elective surgery scheduling in a tertiary hospital.

Using a quasi-experimental design, surgical cancelations were compared before and after the checklist was made mandatory for the same period (6 months each evaluation). The digital checklist was designed to verify fulfillment of 12 essential medical and administrative criteria required for surgical readiness. Comparative analysis was conducted using Chi-square tests, and relative risk was calculated to estimate the likelihood of surgical cancelations.

Results showed a significant reduction in cancelations from 28.1% to 20.5% (P < .0001; 95% CI [0.046-0.108]). The most frequent reasons for cancelations were operating room unavailability and changes in patient conditions. Surgical procedures without a checklist were 20.2% more likely to be canceled than those with a checklist (relative risk 1.20, 95% confidence interval [1.11-1.30]).

The intervention highlighted the importance of complete preoperative evaluations and administrative readiness. Implementing a structured checklist in the surgical calendarization process improved resource use and reduced delays. These findings support integrating such tools into hospital protocols to optimize surgical workflow and minimize avoidable cancelations.